| NPI | 1568693687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: NY 006851) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: PA TE008381) |
| Enumeration Date | 2009-08-06 |
| Last Update Date | 2009-08-06 |